BACKGROUND: This study examined the clinical effects of leuprolide acetate in sexual offenders with paraphilic disorders evaluated by means of objective psychiatric assessment. METHODS: The subjects of this study were seven sexual offenders who were being treated by means of an injection for sexual impulse control by a court order. They had been diagnosed with paraphilia by a psychiatrist based on the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) and had been put on probation by the Ministry of Justice between January 2016 and December 2016. RESULTS: After twelve months, we observed significant improvement in symptoms, as decrease of abnormal sexual interest and activity, sexual fantasy, Clinical Global Impression-Severity (CGI-S), and Clinical Global Impression-Impulsivity (GCI-I). There were a mild feminization of the body shape, feelings of fatigue, and mild hot flushes. No other adverse effect was reported. CONCLUSION: These results suggested that the clinical effects of leuprolide acetate in sexual offenders might be an effective treatment and safety strategy.
Criminals* ; Diagnostic and Statistical Manual of Mental Disorders ; Fantasy ; Fatigue ; Feminization ; Humans ; Leuprolide* ; Paraphilic Disorders* ; Psychiatry ; Sexual Behavior ; Social Justice ; Therapeutic Uses*

Recent studies have suggested an association of genetic and neurodevelopmental factors with development of paraphilia. In this case report on monozygotic twins with pedophilia, we aim to offer additional evidence indicating that genetic vulnerability may be a significant risk factor along with environmental influences on development of pedophilia. These twin pairs, who have been arrested for sexual offenses against boys, had experienced emotional and physical abuse during their childhood, and the older twin brother is reported to have a history of sexual abuse. Both showed homosexual tendencies, and the younger twin brother was also diagnosed as exhibitionism. This case implies greater involvement of genetic factors and associated vulnerabilities in the etiology of paraphilia, including pedophilia, than environmental factors such as childhood abuse. In the future, conduct of research will be needed in order to determine the biological markers related to the etiology of pedophilia.
Biomarkers ; Exhibitionism ; Homosexuality ; Humans ; Paraphilic Disorders ; Pedophilia* ; Risk Factors ; Sex Offenses ; Siblings ; Twins, Monozygotic*

The self-insertion of foreign bodies into the urethra to obtain sexual gratification is an uncommon paraphilia and may be complicated by their passage into the urethra and subsequent difficulties in recovering the foreign body. There are two key areas of discussion in relation to this issue: (1) the psychological aspects of the action and (2) the possible treatment options. With careful attention to the patient's history, it is usually possible to identify the foreign body and the time since insertion. In most cases, the individual seeks emergency surgical treatment. Radiological evaluation is necessary to determine the exact size, location, and number of objects. Endoscopic retrieval is usually successful, but open surgical removal is required in some cases. We present two cases of self-insertion of foreign bodies into the urethra.
Emergencies ; Foreign Bodies ; Humans ; Male ; Paraphilic Disorders ; Urethra*

The purpose of this study was to develop the CORE Program for sex offenders and to determine its effectiveness. The CORE Program was designed with an aim to achieve cognitive restructuring, improve the ability to empathize in interpersonal relationships, and enhance self-esteem and intimacy. We conducted this program over 48 sessions for 28 sex offenders. The effectiveness of the program was evaluated using the Interpersonal Responsiveness Index (IRI), Self-esteem Questionnaire (SEQ), UCLA Loneliness Scale (UCLALS), Coping Using Sex Inventory (CUSI), Rape Myth Acceptance Scale (RMAS), and Wilson's Sex Fantasy Questionnaire (WSFQ). The data were analyzed using paired t-tests. Our results showed no significant changes in the SEQ, UCLALS, and IRI scores after the treatment program. However, the scores for the CUSI, RMAS, and WSFQ significantly improved after this program. In this paper, we demonstrate the effectiveness of the CORE Program for sex offenders. We also discuss the limitations of our study and provide suggestions for future research. Our findings indicate that this treatment program should be provided to sex offenders for preventing recidivism.
Criminals ; Fantasy ; Humans ; Loneliness ; Paraphilic Disorders ; Rape ; Surveys and Questionnaires

This study investigated the effect of leuprolide acetate treatment on sex offenders' sexual fantasies and behaviors, as well as on their criminogenic psychological character and the risk of second conviction. The study participants consisted of 22 sex offenders who were confined to the National Institute of Forensic Psychiatry. Among them, 9 patients were given off-label leuprolide acetate for three months to inhibit sexual impulses, whereas the others were not given any medication. All sex offenders underwent two psychological evaluations; the first evaluation was conducted before starting medication, and the second was conducted after medication. Wilson's Sex Fantasy Questionnaire (WSFQ), the Rape Myth Acceptance Scale (RMAS), and the Endorsement of Violence Scale (EVS) were used for evaluation. Leuprolide acetate-treated sex offenders showed a statistically significant decline in the total WSFQ score (p < 0.05). However, the RMAS and EVS scores did not differ after leuprolide acetate treatment, indicating that cognitive distortions like rape myth acceptance and endorsement of violence were unchanged after leuprolide medication. Leuprolide acetate may reduce deviant sexual impulses and fantasies, as suggested by previous research form Korea and other countries. However, it probably cannot alter cognitive distortion. On the basis of these findings, we recommend a combination of leuprolide medication and other therapies, like cognitive behavioral therapy, for the treatment of paraphilic sex offenders.
Cognitive Therapy ; Criminals ; Fantasy ; Forensic Psychiatry ; Humans ; Korea ; Leuprolide ; Paraphilic Disorders ; Rape ; Violence ; Surveys and Questionnaires

Sexual violence crime causes severe trauma to victim's family as well as the victim, and its aftereffect which is hard to be healed can last for the entire lifetime. And thus plenty of social cost is incurred due to the crime. It has long been reported that paraphilia is associated with sexual offenders and sexual violence. In this study, the previous foreign data on the psychiatric medication used for sexual offender or paraphilia were summarized for the first time in Korea, and the possibility of medication in Korea was examined. As for the drugs used for sexual offender or paraphilia, SSRI was most frequently reported and besides that, tricyclic antidepressant, antipsychotics, antiepileptic drugs, mirtazapine, and naltrexone were reported.
Anticonvulsants ; Antipsychotic Agents ; Crime ; Criminals ; Humans ; Korea ; Mianserin ; Naltrexone ; Paraphilic Disorders ; Sex Offenses

The current study evaluated DSM-IV psychiatric diagnoses and investigated the psychological characteristics of sexual offenders by using the Hypersexual Behavior Inventory(HBI), Sexual Addiction Screening Test (SAST), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Fifty male sexual offenders and 36 male healthy controls completed the psychiatric diagnosis and 30 of the 50 male sexual offenders completed the psychological tests listed above. Thirty-two of the 50 sexual offenders were patients with paraphilias, these sexual offenders had been admitted by the Ministry of Justice to the Institute for Forensic Psychiatry in Gongjui-si due to sexual violence. Participants displayed high lifetime rates of psychiatric disorders: 32 (64%) had paraphilias, 16 (32%) had depressive disorders, 10 (20%) had anxiety disorders, 9 (18%) had impulse control disorders, 6 (12%) had schizophrenia, 2 (4%) had bipolar disorders, and 16 (32%) had personality disorders or some other Axis II disorder. Scores for the sexual offenders were significantly higher both on the HBI and the SAST than the comparison group. Scores for the sexual offenders were also higher for the BDI and the BAI as compared to the control group, but this difference was not statistically significant. Results indicate that sexual offenders may have sexual addictions and be hypersexual. In addition to depressive and anxious psychopathologies, they also seem to have sexual psychopathologies. These results suggested that the psychopathology of sexual offenders may be different than that of a control group.
Anxiety ; Anxiety Disorders ; Axis, Cervical Vertebra ; Bipolar Disorder ; Criminals ; Depression ; Depressive Disorder ; Diagnostic and Statistical Manual of Mental Disorders ; Forensic Psychiatry ; Humans ; Disruptive, Impulse Control, and Conduct Disorders ; Male ; Mass Screening ; Mental Disorders ; Paraphilic Disorders ; Personality Disorders ; Psychological Tests ; Psychopathology ; Schizophrenia ; Sex Offenses ; Social Justice

The aim of this study was to evaluate the legal features of sexual offenders with mental disorders without paraphilia. Patients admitted to Korea Forensic Hospital from 1994 to 2012 (n = 193) were reviewed for diagnosis, crime, legal responsibility, readmission (number of admissions), hospitalizations, criminal record, and education level. Psychotic subjects were often declared not guilty because of insanity and avoided legal responsibility, but had long admission periods and fewer criminal records. Mentally retarded subjects also had long admission periods and fewer criminal records, but commited more sexual offenses against victims aged 13 and younger. The substance abuse group had extensive criminal records, shorter admission periods, and frequent admissions. Subjects with personality disorders and others committed relatively more violent crime with injuries, rather than simple sexual offenses. Treatment and social concerns suitable to each diagnosis are required to address sexual offenses associated with diverse legal characteristics.
Aged ; Crime ; Criminals ; Hospitalization ; Humans ; Korea ; Mental Disorders ; Mentally Disabled Persons ; Paraphilic Disorders ; Personality Disorders ; Substance-Related Disorders

OBJECTIVES: In an effort to increase understanding of the relationship between sexual violence and mental illness, we conducted an investigation of the prevalence of psychiatric illness and associated psychological features of sexual offenders. METHODS: Twenty-two male sex offenders were referred for psychiatric diagnosis from the prosecutor's office and admitted to the hospital between August 2010 and May 2011. In order to identify Axis I and II disorders, including sexual disorders, we conducted the Korean version of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition. All participants completed psychological assessment batteries, including the Korean-Wechsler Adult Intelligence Scale, and self-report scales, including the Barratt Impulsiveness Scale, State-Trait Anger Expression Inventory, and the Rape Myth Acceptance Scale. Information on participants' legal, personal, and psychiatric family histories was also gathered. RESULTS: Many of the participants received diagnosis of Axis I disorders : Eight subjects (36.4%) had paraphilia, and five (22.7%) had pedophilia. Two subjects (9.1%) had schizophrenia, five (22.7%) had depressive disorder, and three (13.6%) had alcohol dependence. Participants also showed high rates of Axis II disorders : four of them (18.2%) had mental retardation or borderline intellectual functioning and seven (31.8%) had cluster B personality disorders. Participants' serum free testosterone level showed statistically significant correlation with motor impulsiveness (p<0.05). CONCLUSION: Sex offenders included in this study displayed high rates of mental illness, including paraphilia and intellectual disability. On the basis of our findings, we asserted that sex offenders should undergo careful evaluation for mental illness, and that management programs for sex offenders should include psychiatric evaluation and intervention.
Adult ; Alcoholism ; Anger ; Axis, Cervical Vertebra ; Criminals ; Depressive Disorder ; Humans ; Intellectual Disability ; Intelligence ; Korea ; Male ; Mental Disorders ; Paraphilic Disorders ; Pedophilia ; Personality Disorders ; Prevalence ; Rape ; Schizophrenia ; Sex Offenses ; Testosterone ; Weights and Measures

Paraphilia was a very treatment resistant psychiatric disorder. But new treatment strategies to paraphilia have been introduced recently. We report and review the effect of depot analogue (goserelin) administration in a 18 year-old adolescent with paraphilia. We administered goserelin 3.6 mg/month to him for 3 months, there were changes of scores in Clinical Global Improvement, Sex Addiction Screening Test, Freund Paraphilia Scales.
Adolescent ; Gonadotropin-Releasing Hormone ; Goserelin ; Humans ; Mass Screening ; Paraphilic Disorders ; Weights and Measures